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General NPI Number Information
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NPI Number | 1205481389
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Entity Type | Individual
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Provider Name | GWYNETH BRENNA NELL PHILLIPS BA
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Gender | Female
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Dates
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Enumeration Date | 08/06/2019
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 360 PEAK ONE DR STE 180
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City | FRISCO
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State | CO
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Zip | 80443-5948
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Country | US
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Telephone | 970-668-3633
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Fax |
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Provider Business Mailing Address
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Address Line | 518 BRIAN AVE
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City | SILVERTHORNE
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State | CO
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Zip | 80497-1901
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT.0002698
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | SA.0003217
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License Number State | CO
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